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Review Article| Volume 25, ISSUE 4, P713-731, December 2005

Cytomorphology of Fibrocystic Change, High-Risk Proliferative Breast Disease, and Premalignant Breast Lesions

      It has been known for many years that women who have undergone a breast biopsy for so-called “fibrocystic disease” have an increased risk of breast cancer [
      • Emsler V.L.
      The epidemiology of benign breast disease.
      ,
      • Lov S.M.
      • Gelman R.S.
      • Silen W.
      Fibrocystic “disease” of the breast—a nondisease?.
      ]. So attempts have been made to classify the spectrum of fibrocystic disease into reproducible and prognostically relevant categories. These studies have focused on the relative risk of subsequent development of breast disease in patients who have fibrocystic disease, based on the histological features in their biopsies. These efforts have resulted in introducing a new terminology of nonproliferative breast disease, proliferative breast disease without atypia, and proliferative breast disease with atypia (atypical hyperplasia); and in defining the specific histologic changes associated with each category [

      Page DL, Vander Z, Weig R, et al. Relation between component parts of fibrocystic disease complex and breast cancer. J Natl Cancer Inst 61:1055–63.

      ,
      • Kodlin D.
      • Winger E.E.
      • Morgenstern N.L.
      • et al.
      Chronic mastopathy and breast cancer, a follow-up study.
      ,
      • Hutchinson W.B.
      • Thomas D.B.
      • Hamlin W.B.
      • et al.
      Risk of breast cancer in women with benign breast disease.
      ,
      • Bach M.M.
      • Barclay T.H.C.
      • Cutler S.J.
      • et al.
      Association of atypical characteristics of benign breast lesions with subsequent risk of breast cancer.
      ]. It is generally agreed that nonproliferative breast disease carries no increased risk. Proliferative breast disease without atypia has slightly increased risk (1.5–2 times), and proliferative breast disease with atypia has moderately increased risk (4–5 times) for subsequent development of breast cancer. Patients who have carcinoma in situ have 8 to 10 times the risk of ultimate development of breast cancer [
      • Page D.L.
      Cancer risk assessment in benign breast biopsies.
      ,
      • Dupont W.D.
      • Parl F.F.
      • Hartman W.H.
      • et al.
      Breast cancer risk associated with proliferative breast disease with atypical hyperplasia.
      ].
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